Background and Aim Νon‐alcoholic fatty liver disease (NAFLD) is estimated to be the most common cause of end‐stage liver disease in the next years. Vitamin E has shown beneficial effects as a possible “scavenger” of oxidative stress products, which play a major role in pathogenesis of the disease. The purpose of the present meta‐analysis is to investigate the effects of vitamin E supplementation in biochemical and histological parameters in adult patients with NAFLD. Methods Literature search was performed in major electronic databases (MEDLINE, CENTRAL, and Embase) up to June 2020 for randomized clinical trials, which examined vitamin E versus placebo treatment in adults with NAFLD. Changes in liver enzymes were considered as primary outcomes while changes in histological, biochemical, and metabolic parameters as secondary. Quality of evidence was assessed through risk of bias according to the Cochrane risk of bias tool. Results Eight studies were included in qualitative analysis and seven in quantitative analysis. Vitamin E reduced the values of liver enzymes compared with placebo (−7.37 IU/L, 95% confidence interval: −10.11 to −4.64 for alanine aminotransferase, and −5.71 IU/L, 95% confidence interval: −9.49 to −1.93 for aspartate aminotransferase). Additionally, vitamin E improved statistically significantly liver pathology in every individual histological parameter as well as low‐density lipoprotein cholesterol, fasting blood glucose, and serum leptin values. Conclusions Vitamin E can improve biochemical and histological characteristics of NAFLD patients, especially of non‐alcoholic steatohepatitis patients. The results indicate that vitamin E could be a promising choice and be considered as a treatment option in patients with NAFLD.

Objectives: We conducted a systematic review and meta-analysis to provide a summary of the current literature about the efficacy of probiotics in pediatric nonalcoholic fatty liver disease (NAFLD). Methods: A systematic literature search through major electronic databases was carried out for RCTs till September 9, 2021, investigating the efficacy of probiotics in the treatment of pediatric patients with NAFLD. Weighted mean differences (WMD) and Standard Deviations (SD) were used to calculate continuous outcomes and a Risk Ratio with 95% CI was used for dichotomous outcomes. Results: In total, 4 RCTs with 238 pediatric patients with NAFLD were included in the study. Probiotic supplementation revealed a statistically significant difference in transaminases' levels (ALT: WMD = -7.51 IU/L, 95% CI, -11.28 to -3.73, I 2 = 0%, P < 0.0001; AST: WMD = -6.46 IU/L, 95% CI, -9.31 to -3.61, I 2 = 0%, P < 0.00001), anthropometric characteristics, total cholesterol, triglycerides and ultrasonographic steatosis improvement. Conclusions: According to the data of this meta-analysis, probiotic supplementation, and especially supplementation of Lactobacillus acidophilus in combination with other strains of Bifidobacterium or Lactobacillus may be beneficial in the improvement of transaminases', lipid parameters' levels, ultrasonographic, and anthropometric characteristics in children with NAFLD. Current evidence does not allow specifying the exact beneficial strain of probiotics mentioned above. The possible effect of probiotics on liver histology improvement in pediatric NAFLD should be examined in future studies.

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